Saturday, September 19, 2009

Why Medical School Equals Awesome

Two weeks ago I couldn't have described to you the structure of the inner ear, let alone the physics behind what happens when sound waves strike the tympanic membrane or how movement of the hair cells in the cochlea are translated into neurotransmitters. I didn't know that there are members in the Deaf community against the use of cochlear implants or that we have muscular mechanisms in place which dampen the sound of our own voices to ourselves.

Already I can look back over the past three weeks of school with some astonishment at the volume of information that has been thrown in our direction.The information we have gathered and disseminated amongst each other, the flash cards, the youtube videos, online dissections...I am sure part of this cooperative process has something to do with the fact that we only receive pass/fail grades for the first 2 years of our program, thus decreasing the competition factor by a notch or two.

Our program is structured using problem based learning. We are in groups of 8-10 and each week we are presented with a case study. We work through the various differentials as a group and come up with the likely diagnosis. Then we decide what learning objectives we need to tackle and are left to our own devices to gather that material, learn it, then return 4 days later to discuss it. Present in our groups is a physician who acts as a facilitator but not a resource, they are basically there to make sure we are meeting the curriculum goals and staying on track (and not teaching each other a bunch of misinformation). My group consists of 4 biochemists, one PhD microbiologist, a geologist, a biologist and a biomedical engineer.

2 weeks ago our case study was regarding a patient with sensorineural and conductive hearing loss. The case is revealed in stages during the two sessions on Tues/Fri...then the following Tuesday we have a 1 hr wrap-up and begin the next case. Since G.M had hearing difficulties our anatomy, physiology, histology, and clinical skills lectures were all based on the ear and examining it. Our guest lectures were from an ENT specialist, a patients rights advocate/medical legal advisor, a community physician, a speech/language pathologist, and a sociologist. All the discussions were focused mainly on the impact of hearing loss from the biochemical level to the community level. I found the amount of information that I retained MUCH greater than I would have anticipated. I am certain that the 'learning in context' aspect of the delivery had much to do with that.

What is astonishing to me is the truth behind, the more you know...the more you realise you don't know. This has been glaringly evident since day one of medical school. As an ER/community nurse I have to know a little about everything regarding primary care. Apparently--very little about everything.

How did I spend so many years in nursing school and 6 years as a nurse yet understand so little about the organism I was dealing with?

The other amazing thing is how each and every day I see a large gap in my knowledge filled-in ever so slightly. Something I've never understood before or always wondered about becomes crystal clear...from major to minor 'AHA!' moments. I am fascinated by the material we are learning, from the work of the smallest muscle in the body (the stapedius) to the social impact of 'fixing' an 'impairment' (cochlear implants).

It almost feels like a scam sometimes--I have the privilege of getting to learn full time about something that enthralls me--and at the end of it, I get to be a doctor!! What? How cool is that?!

And now...as this weeks case has a blood disorder...I must return to the pages of my physiology text and attempt to wrap my head around the structure of the hemoglobin molecule.

I thought CBL was useless when we did our undergrad (for the most part) because the structure of our program did not adhere to the major tenants of CBL/PBL, i.e. our class sizes of sometimes >20 people, using grades/exams as evaluating tools, poorly qualified (and overall absent) tutorial instructors, lack of outside review of the presented info, a cohort unfamiliar with self-directed learning and research...I could go on.

Yet, here they work really hard to ensure the delivery is as close to the ideal model of CBL as possible, and the difference really shows. IN this setting I agree, CBL is an awesome way to learn. Especially for me (the crusty old extrovert that I am...)

Good to hear that you're enjoying it...I definitely had the opposite of CBL and it was painful and tedious at many points. I think that one of the advantages of CBL is that it prepares you to think like a clinician instead of memorizing lots of "high yield" stuff for a couple years. Keep up the enthusiasm!!!

OMDG--Yeah it is cool! Nice to be surrounded by nerds too. Normalizes my nerdiness.

WH--Yeah, I was hoping you'd return to the blogosphere someday! Welcome back.

BINY--My enthusiasm waned this afternoon I must admit...somewhere during the memorizing of enzymes to do with O2 and C02 transport. Blah. But it picked up again when I got to the osteomyelitis patho. Mmmm....disease patho...so sexxxxy.

Currently Reading

"I cannot rest from travel; I will drink Life to the Lees. All times I have enjoyed Greatly, have suffered greatly, both with those That loved me, and alone; on shore, and when Through scudding drifts the rainy Hyades Vext the dim sea. I am become a name; For always roaming with a hungry heart..." Lord Tennyson